Active NPI
Nathan Simon, MASSAGE THERAPIST
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1679358584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61102640
- Practice address
- 4001 NE 130TH St
Vancouver, WA 98686-2670 - Phone
- (360) 901-5890
- NPI assigned
- Aug 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA61102640 | WA | Primary |
Addresses
Primary practice location
4001 NE 130TH St
Vancouver, WA 98686-2670
Mailing address
4001 NE 130TH St
Vancouver, WA 98686-2670
Phone (360) 901-5890
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA61102640 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Halcumb Family Chiropractic | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1679358584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 NE 130TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986862670",
"telephone_number": "360-901-5890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 NE 130TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986862670",
"telephone_number": "360-901-5890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "NATHAN",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-29",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61102640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.